ffs surgeons who take insurance ffs surgeons who take insurance

For additional assistance with any information contained within this packet, please contact: Oakland MST Department: (510) 752-7149. These are difficult to quantify as our institutional billing activities are centralized and carried out by multiple administrators. Facial Reconstruction: Gender affirming facial surgery is considered reconstructive when all of the following criteria have been met: The individual is at least 18 years of age; and 3. This document is a general guide to national resources, but because of the state-specific nature of most insurance regulation, I highly suggest you attempt to reach out to local experts who are better able to advise you to your situation. Facial feminization surgery can be covered by health insurance in some instances. These procedures are also called Facial Feminization Surgery or FFS, but in agreement with the experts, I've shifted to using FGCS. Integral to this whole process is the FGCS surgeon. Each patient is different and your expectations and desired results will be discussed fully in your consultation. Submission and review of initial authorization request (1 month); 2. On average, Dr. Keojampa is booking 8-12 months out for Aesthetic Craniofacial Surgery and Facial Feminization Surgery. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. Jess Ting - Plastic and Reconstructive Surgery | Mount Sinai - New York Home Profiles Mount Sinai Doctors Video Visit Available Accepting New Patients Jess Ting, MD Plastic and Reconstructive Surgery 4.6 Star s | 32 Responses CTMS 212-870-8270 View location details Book an Appointment About Me Clinical Focus Video Education & Certifications Awards 2020 Deschamps-braly clinic. (See table 2, Supplemental Digital Content 2, which displays the total time and cost of the insurance approval process per group. Dr. Keith is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. For more information, please refer to our Privacy Policy. 13. Policy Title: Gender Affirming Surgery. 6. In NY, we have the benefit of a clear history of coverage through Medicaid, and plenty of pro-bono legal teams able to help patients with denials. Dr. Harris is a highly skilled, board-certified Surgeon in the Dallas area who has been developing an international reputation for transgender surgery. Dr. Esmonde is a plastic surgeon in Portland, Oregon who has extensive knowledge about Gender Affirmation Surgery and works almost exclusively with transgender and non-binary patients. Also referred to as Facial Gender Confirmation Surgery (FGCS), these procedures are becoming more and more popular, and increasingly are covered by insurance. I don't philosophically agree with this. Each letter should state "this procedure is medically necessary treatment. With all letters, I advise providers to be as authoritative in their tone as possible, and to explicitly claim an expert status if appropriate. 3). A surgeon who takes your insurance, hopefully in-network or willing to do the legwork of a single case agreement, with whom you are ready to move forward in planning surgery. Allure Esthetic & Insurance Coverage For FFS Allure Esthetic is Washington State's top destination for facial feminization surgery. These delicate procedures change the male facial patterns to a softer, feminine appearance. We believe that for many transgender women, FFS is medically necessary to treat gender dysphoria. Woolhandler S, Campbell T, Himmelstein DU. Policy Issued By: Anthem. Until then, CCTS will continue to require all patients using insurance for . The objective is to soften the facial . Read your cover in detail and find out the following: Second, find out if yourCertificate of Coveragehas any inclusions (or exclusions) around transgender care. In total, attempting and succeeding at obtaining insurance coverage for FFS is a significant time and cost burden that may be difficult to overcome for a number of plastic surgical practices, suggesting ramifications for patient accessibility. Also known as facial feminization surgery or FFS, this is a general term for a group of procedures designed to change the bone structure . Doctors and nurses take good care. Facial feminisation surgery can involve a combination of all or some of the below cosmetic procedures. JAMA Surg. I can't guarantee that you'll achieve coverage, but depending on how your insurance benefits are regulated and the support resources you have access to, it's definitely worth trying. It can be just as important or even more important than sex reassignment surgery (SRS) in reducing gender dysphoria and helping trans women integrate socially as women. Plast Reconstr Surg. Look here for licensed dentists practicing in the state. I am working from the perspective that you are unable to pay in full and be reimbursed. In Patient X's case, she has achieved the full extent of facial feminization that can be expected with hormone therapy. Mallory C, Tentindo W. Medicaid coverage for gender-affirming care. You need an understanding of your insurance benefits in general: What would any covered surgery cost you? This is also the point at which general 201 level guidance ceases to be useful. Your insurance might have a requirement about length of time in care with them, or degree level. The analysis was done by identifying individual steps involved in the insurance process (Fig. See the list at the end of this article for surgeons who will accept some form of insurance benefits directly.What makes someone a FGCS surgeon anyway? Dr. Facque is a board-certified plastic surgeon in San Francisco, California who started providing gender-affirming care in 2012 and has worked exclusively with transgender and non-binary patients since 2020. These patients underwent a standard approval process no different from other reconstructive procedures (Group A). 12. 2010; 19:10191024. 14. Because the plastic surgeon is not paid on an hourly or salary basis, the national average salary was used.8,9 The estimated cost of the insurance process per patient was calculated by combining the hours spent per step and compensation rates. Patients who receive prior authorization are still required to pay for the cost of their facial feminization surgery in advance. Forehead (frontal bone recontouring, recontouring of superior orbital rim, hairline lowering). Lastly, the time consumption, costs, and difficulties to the patient were not assessed. These IMRs are often requested through the California Department of Managed Healthcare resulting in state-mandated overturn of the insurance decision, or less commonly, through the insurance company for ERISA or self-insured plans which do not fall under state jurisdiction. We recommend you take at least two weeks off from work to recover, but expect up to six to eight weeks of decreased activity. 1). If it is substantial, they should name their years of experience working with transgender patients. Dr. Ellie Zara Ley, MD is an accomplished board-certified plastic surgeon who had more than 15 years of specialized training in plastic, craniofacial and micro surgery before learning the art of Gender Confirmation Surgery. From the *Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif. UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, Calif. Plans that fall into this group include Medi-Cal, Medicare, and some private insurance plans. Dr. Hadeeds practice now has two locations: Beverly Hills, California and Miami, Florida. 2003; 349:768775. This could be a good time to join (or form!) 2. The doctor said very encouraging. Privacy Policy (Updated December 15, 2022). A total of 40 transfeminine patients were identified (mean age 35.6 2.2 years) (Table 1). No. Our surgeons specialize in a variety of facial feminization procedures, such as forehead reduction, jaw contouring, and chin surgery. Dr. Sajan places the highest priority on providing his transgender patients with excellent surgical care and natural-looking results. Listings for surgeons outside of the New York area are compiled only for surgeons who perform some combination of genital surgery or FGCS, . Second, while complications are not high in FFS, they may occur. Furthermore, revisions may be indicated in some patients over time. A report last year from the Center for American Progress found that 40 percent of transgender respondents and 56 percent of trans respondents of color said their health insurance companies. Available at: 2. He has been performing gender surgery since 2005. Patients were stratified into 3 groups based on authorization process: Group A (standard approval, n = 26, 65.0%) including public and private insurances; Group B (extended approval, n = 10, 25.0%) consisting of private insurance plans that initially denied and required multi-level appeals for denial overturn; and Group C (denial, n = 4, 10.0%), including private insurance plans that denied even after multi-level appeals. See all insurance information. 4. Recognized for his exceptional surgical skills and natural-looking results, Dr. Raminenis patients also praise his friendly, compassionate and professional nature. 2010; 170:17281734. We identified all patients with gender dysphoria consulted for FFS under a single surgeon (JCL) at the University of California Los Angeles between January 2018 and February 2020 (n = 55). Read more. ), You will also need to factor in the costs of airfare, transportation, and accommodation if youre not from the San Francisco Bay Area. In most cases, it is still extremely difficult to get your FFS surgery reimbursed by your insurance. Please read a few important elements consider when booking. Finally, you should have an idea of your local resources. LGBT legal service projects? Procedures requested for facial feminization insurance authorization are detailed in Table 2. 3). Medi-Cal, the California state equivalent of Medicaid, authorizes all gender-affirming surgeries including FFS and Medicare does not require prior authorization. Insurance authorization process for FFS.The insurance authorization process for FFS begins with submission of two letters of support from a mental health provider and primary care physician following surgical consult. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve. Dr. Freet leads a multidisciplinary team at the University of Texas that performs both male-to-female and female-to-male surgery procedures, including facial and chest surgeries as well as Vaginoplasty, Metoidioplasty and Phalloplasty. Tseng P, Kaplan RS, Richman BD, et al. Braun TL, Braun JL, Hernandez C, et al. 2018; 80:198204. Among the 26 patients (65.0%) who underwent the standard approval process, 13 patients had Medi-Cal, 4 patients had Medicare, and 9 patients had private insurance. The lady on the phone told me the surgery usually ranges from $60-100,000 dollars. Post Surgery Recovery. Descriptive statistics were performed for demographic variables. He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization. Facial feminization surgery is more often referred to as "gender reaffirmation surgery", and is performed on . P. Daniel Knott, MD, and Andrea Park, MD from the UCSF Facial Plastic Surgery practice in the Division of Head & Neck Surgery. For example, some may be reluctant to perform an osteotomy of the anterior table of the frontal bone for setback in an outpatient surgery center and, thus, default to a less aggressive method of frontal bone recontouring, which may be an undercorrection for certain patients. Price (USD) Forehead Recontouring. Dr. Meltzer is a plastic and reconstructive surgeon who has been performing Gender Reassignment Surgery since the early 90s. A total of 33 patients between 19 and 40 years of age were referred for facial feminization surgery between January of 2003 and December of 2013, for a total of 180 procedures. This study highlighted the successes and burdens associated with obtaining insurance authorization for FFS. . It is of great importance to note that there is no one-size-fits-all solution for facial gender affirmation with respect to determining medical necessity of procedures. Dr. Sajan performs the following Facial Feminization Surgery procedures at his state-of-the-art facility in Seattle, Washington. In total, the time consumption of the insurance process was 12.0 1.6 hours and cost $988.38 101.76 per patient. Please try after some time. Body-contouring. The work cannot be changed in any way or used commercially without permission from the journal. Referral letters and supporting documentation should be sent to: UCSF Gender Affirming Health Program 1725 Montgomery St. Suite 250 San Francisco, CA 94111 Phone: 415-885-7770 Fax: 415-353-3399 transcare@ucsf.edu 2). This might be the hardest part- no one should have to compromise quality, and the big names in FGCS have historically not taken insurance, though its my observation that this is rapidly changing. NOTE:The following is intended as ahigh-level overview and guide onlyand does not in any way constitute legal or professional advice. This is highly considered one of the most "life-altering" surgeries for a transgender patient because the impact is visible right away. In addition, many of them don't take insurance. James S, Herman J, Rankin S, et al. Temporal trends in gender-affirming surgery among transgender patients in the United States. You will be asked to complete an intake questionnaire before your consultation. This operation is most commonly performed in transgender women or non-binary people as a type of gender-affirming surgery. We performed a cost analysis of the pre-surgical insurance process for patients seeking FFS. The remaining 10.0% of patients who were ultimately denied were counseled and in the process of exiting their job-based insurance plan and enrolling for coverage through plans under the health insurance exchange established by the Affordable Care Act, which fall under state jurisdiction. I recommend the pioneer of FGCS, Dr. Douglas Ousterhouts book, Facial Feminization Surgery: A Guide for the Transgendered Woman for those looking to learn more about what skill and training is involved and a breakdown of procedures as he performed them, but Ill attempt to summarize. In total, the time and cost estimate of the insurance appeal process was 10.8 1.0 hours and $855.00 91.53 per patient, respectively. For trans men, women and gender-nonconforming clients in Los Angeles, Santa Monica, San Diego and elsewhere in Southern California, Dr. Youssef offers Top Surgery, Breast Augmentation and Facial Feminization Surgery. For self-pay patients, cost will frequently dictate the operative and postoperative setting such that patients may be preferentially or solely performed in an outpatient setting. Please note that before you can schedule . Male-to-female (MTF) facial feminization. Administrative costs associated with physician billing and insurance-related activities at an academic health care system. Unlike California-insured plans, job-based plans which are self-insured, also called Employee Retirement Income Security Act (ERISA)-plans, a second-level, patient-initiated appeal is typically required. Insurance coverage for FFS is an important issue for a number of reasons for both patients and surgeons. If not, remember youre never alone and there are a range of transgender support agencies that you can tap into. The generalizability of the findings presented here is limited by state laws. 1. 10. Plastic and Reconstructive Surgery - Global Open, Get new journal Tables of Contents sent right to your email inbox, Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-FINAL.PDF, https://blog.doximity.com/articles/doximity-2018-physician-compensation-report, PRSGO_9_5_2021_03_23_LEE_GOX-D-21-00105_SDC2.pdf; [PDF] (74 KB), Facial Feminization Surgery under Insurance: The University of California Los Angeles Experience, Articles in Google Scholar by Allison C. Hu, BA, Other articles in this journal by Allison C. Hu, BA, Factors Influencing the Choice of Plastic Surgery as a Specialty in Saudi Arabia, Outcomes of Implant Removal and Capsulectomy for Breast Implant Illness in 248 Patients, A Safe and Effective Lip Augmentation Method: The Step-by-Step (Phi) Technique, Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence. Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. We can't guarantee insurance coverage but we can guarantee to try our hardest! Coordinating presurgical authorization required an average of 7.8 1.5 hours per patient for the administrator and 4.3 0.5 hours per patient for the attending craniofacial surgeon to navigate multi-level appeals. The time and costs necessary to achieve approval from insurance plans for FFS are not trivial. information about insurance coverage: video.transcendlegal.org 2.